At Boston Children's Hospital, success is measured in patients treated, parents comforted and teams taught. It's in discoveries made, processes perfected, and technology advanced. In major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As a teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Patient Financial Services Department and discover how your talents can change lives. Yours included.
This Supervisor of Out-Of-Network Agreements will be responsible for:
Overseeing the activities of the Out of Network Agreements Team responsible for negotiating all single case agreements with out of network/out of state non-contracted payers.
Conducting financial assessments on the relative risks to the Hospital & Physicians Organization of accepting complex, high acuity patients who have non-contracted payers & providing the assessment to the Out of Network Assessment Team, Foundation Chiefs, CMO and EVP of Health Affairs for review.
Overseeing the analysis of payer requirements, contracting standards, claims payment history & provider & facility enrollment guidelines for non-contracted payers.
Managing complex cases escalated by the Out of Network Assessment Team. Working with plans, State Medicaid agencies, BCH General Counsel, Contracting, clinical staff, Senior Clinical Leadership, Government Relations, and families/patients.
Supervising & supporting staff in accordance with hospital policies and in consultation with department manager.
Maintaining knowledge of payer rules, regulations, policies/procedures as they impact the billing process.
Developing/maintaining relationships with payer organizations in order to facilitate appeals of payer decisions.
Working with director, sharing critical information and statistical data, and developing strategies that will enhance the department's performance.
Developing/ negotiating fees, credentialing requirements, utilization & quality standards, contract language, performance standards & amendments as part of single case agreements.
Analyzing contract requirements, special provisions, terms & conditions to ensure compliance with appropriate laws, regulations, and hospital & physician group policies & procedures.
To qualify, you must have:
A Bachelor's degree in Health Care Administration, Finance or a closely related field & at least 5 years of experience preparing, negotiating and executing complex single case agreements as well as Revenue Cycle operations related to healthcare.
EPIC Experience preferred.
The analytical skills to design & enhance moderately complex hospital systems and programs, resolve problems requiring a comprehensive & awareness of the technology & literature in a professional, technical or scientific field, or develop financial & operating plans for a large department/division.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including a flexible schedule, affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes. Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 3025621
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.